Donation Details

Your name

Your address

1st address line*

2nd address line

3rd address line

Town*

County*

Postcode*

Contact info

Your Telephone Number

Your Email Address*

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Gift Aid

I would like EIA to reclaim the tax I have paid on all my donations in the past four years and any future donations I may make, until I notify you otherwise. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

I confirm I am the only signatory required to authorise this Direct Debit

The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits

If there are any changes to the amount, date or frequency of your Direct Debit EIA will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request EIA to collect a payment, confirmation of the amount and date will be given to you at the time of the request

If an error is made in the payment of your Direct Debit, by EIA or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society

If you receive a refund you are not entitled to, you must pay it back when EIA asks you to

You can cancel a Direct Debit at any time by simply contacting confirmation may be required. Please also notify us.

Payment details

{Is the account in your name? (I confirm the account is in my name):24.1}

{Are you the only signatory required to authorise this Direct Debit? (I confim I am the only signatory required to authorise this Direct Debit):25.1}

{Gift Aid:26.1:value}

Your details

Address
{1st address line:6}
{2nd address line:7}

Town
{Town:9}

County
{County:10}

Postcode
{Postcode:11}

Email address
{Your Email Address:15}

Confirmation of the Direct Debit set up will be sent to you within 3 working days or no later than 10 working days before the first collection.

Instruction to your Bank or Building Society:
Please pay EIA the Direct Debit from the account detailed in this Instruction subject to the
safeguards assured by the Direct Debit Guarantee. I understand
that this Instruction may remain with EIA and, if so, details will be passed electronically to my Bank / Building Society.

Donate via Credit Card

I would like to donate:

£5

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£

Title

First name *

Last name *

House number / name *

Street name *

Town/City *

County/Region *

Postal/Zip code *

Telephone

Email *

I would like EIA to reclaim the tax I have paid on all my donations in the past four years and any future donations I may make, until I notify you otherwise. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.